Atomic-level structural investigation of the key conformational intermediates of amyloidogenesis remains a challenge. Here we demonstrate the utility of nanobodies to trap and characterize intermediates of β2-microglobulin (β2m) amyloidogenesis by X-ray crystallography. For this purpose, we selected five single domain antibodies that block the fibrillogenesis of a proteolytic amyloidogenic fragment of β2m (ΔN6β2m). The crystal structure of ΔN6β2m in complex with one of these nanobodies (Nb24) identifies domain swapping as a plausible mechanism of self-association of this amyloidogenic protein. In the swapped dimer, two extended hinge loops-corresponding to the heptapetide NHVTLSQ that forms amyloid in isolation-are unmasked and fold into a new twostranded antiparallel β-sheet. The β-strands of this sheet are prone to self-associate and stack perpendicular to the direction of the strands to build large intermolecular β-sheets that run parallel to the axis of growing oligomers, providing an elongation mechanism by self-templated growth.crystallization chaperones | amyloid fibrils | prefibrillar intermediates | dialysis-related amyloidosis P eptides and proteins exhibit a common tendency to assemble into highly ordered fibrillar aggregates, whose formation proceeds in a nucleation-dependent manner (1, 2). The full elucidation of the aggregation process requires the identification of all the conformational states and oligomeric structures adopted by the polypeptide chain. Atomic-level structural investigation of the key conformational intermediates of amyloidogenesis remains a challenge. This is due to the nature of the process, which may be described as a dynamic equilibrium between diverse structural species. These intermediates have dissimilar sizes and occur in very uneven amounts and time frames. Fibril formation in vivo usually takes several years, and the intermediate species are short living and highly unstable (2). Here we demonstrate the utility of heavy chain only antibodies derived from camel (3, 4) for the structural investigation of prefibrillar intermediates of β2-microglobulin (β2m) amyloidosis. The antigen-binding site of these antibodies consists of a single domain, referred to as VHH or nanobody (Nb) (4).β2m is a 99-residue soluble protein that adopts the classical seven-stranded β-sandwich immunoglobulin fold and is expressed as a key component of the major histocompatibility class I complex (MHC-I) on the cell surface of all nucleated cells (5, 6). In healthy individuals, excess β2m is degraded and excreted from the bloodstream by the kidney. In patients suffering from renal failure, the β2m concentration increases up to 60-fold (7) leading to the formation of insoluble amyloid fibrils and causing dialysisrelated amyloidosis (DRA) (8). In amyloid deposits extracted from DRA patients, up to 25-30% of the constituting β2m is truncated and lacks the six N-terminal amino acids (ΔN6β2m) (9, 10). The ΔN6-truncated form of β2m readily aggregates and fibrillates at neutral pH (10, 11).The identification...